Pituitary Apoplexy Manifesting as Massive Intracerebral Hemorrhage : Case Report

A 68-year-old man presented with severe conscious disturbance caused by pituitary apoplexy resulting in massive intracerebral hemorrhage (ICH). He had been periodically followed up for asymptomatic pituitary adenoma at another hospital for 8 years. Neuroimaging examination revealed pituitary apoplexy and massive ICH located in the left frontal lobe, and the ICH was directly connected to the intratumoral hemorrhage. The diagnosis was massive ICH from pituitary apoplexy. The patient underwent emergent evacuation of hematoma and removal of the pituitary adenoma via bi-frontal craniotomy. Postoperatively, he continued to exhibit deep consciousness disturbance and died 1 month after the operation. Pituitary apoplexy is usually characterized by intra-tumoral hemorrhage. The treatment strategy for asymptomatic pituitary adenoma is still controversial. This case shows that we should always consider the risk of pituitary apoplexy manifesting as ICH which may cause a fatal outcome

Bilateral Chronic Subdural Hematomas of the Posterior Fossae : Case Report

An 86-year-old female presented with rare bilateral chronic subdural hematomas (CSHs) of the posterior fossae which were successfully treated by surgical intervention. She had experienced mild head trauma one month before admission. She was transferred to our hospital because of consciousness disturbance and tetraparesis. Magnetic resonance (MR) imaging showed simultaneous occurrence of supratentorial and infratentorial CSHs. We tried to evacuate the CSHs of the bilateral posterior fossae because brainstem compression was markedly severe. Through bilateral burr-hole trepanations, chocolate-colored fluid, not containing clotted components, gushed out under great pressure. Postoperative course was uneventful. MR imaging revealed that the CSHs of the posterior fossae had completely disappeared and brainstem compression had also improved. The patient's neurological deficits were immediately improved after the operation. The patient was discharged one month after the operation for further rehabilitation. Trepanation and evacuation of the hematoma through the posterior fossa might be one of the therapeutic options for posterior fossa CSH, which is similar to supratentorial CSH. However, we considered that the emergency of this rare entity and the method of anesthesia were quite different from supratentorial CSH

Mollaret Meningitis with a High Level of Cytokines in the Cerebrospinal Fluid Successfully Treated by Indomethacin

A rare case of Mollaret meningitis characterized by four recurrent episodes of aseptic meningitis during a three-year period is reported. The patient showed a high fever and severe headache accompanied by a high level of cerebrospinal fluid (CSF) cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). The symptoms and high CSF cytokines were resolved immediately after introducing indomethacin treatment. Reactivation of the latent virus is considered to be the cause of this rare disease, and indomethacin is believed to inhibit the periodic abnormal generation of eicosanoid in the brain, resulting in a reduction in the fever and subsequent inflammation

Crack growth in Westerly granite during a cyclic loading test

To examine the fatigue process of granite, cylindrical Westerly granite specimens, 10 mm in diameter and 20 mm in length, were subjected to a cyclic loading test under uniaxial compression with a maximum of 140 MPa at room temperature, and crack growth patterns within them were analyzed by microscopic observation and image analysis techniques. The fatigue process is divided into three characteristic stages; a primary stage in which the upper peak strain increases at a decelerating rate (stage I), a second stage with linearly slight increasing rate of strain following stage I (stage II), and the third and final stage in which the upper peak strain increases at an accelerating rate and culminates in specimen failure (stage III). A series of prefailure specimens, of which the stage in the fatigue process was decided by monitoring the strain behavior during the test, were retrieved. In addition, these specimens were compared with specimens stressed to close to the breaking strength by monotonic compression to examine the characteristic features of fatigue. The fluorescent method was applied to identify microcracks within the specimens. The advantage of this method is to provide quick and accurate identification of microcracks with an optical microscope. Microcracks are detected based on a marked difference in brightness under ultraviolet light irradiation because they are fully filled with acrylic resin mixed with a fluorescent substance in advance. Thin sections, including the axis of the specimen, 10 × 20 mm, were prepared for detailed observation after the pretreatment of the method. The results were as follows. At the initial degradation stage, distinguishing crack growth was identified in quartz grains. It is estimated that the slowdown of the strain growth rate at this stage was caused by the decrease in crack growth, that is, the portions with cracking potentiality were damaged at the first or early loading, and no further damage occurred immediately following the first damage. At the second stage, no significant crack growth in quartz grains was identified. On the other hand, in feldspar grains, development of cracks in a preferential direction, parallel to the loading direction, was observed. However, they did not grow into intergranular cracks by cutting across the grain boundaries during this stage. Consequently, it was found that a gradual progress of microcracks within feldspar grains was dominant during the second stage, and this is because the strain growth rate was in a steady and long state. At the final accelerated stage, many intergranular cracks running parallel to the loading direction were identified. It is obvious that these long cracks were formed mainly by the linking and growth of the intragranular cracks in feldspars, which were generated during the former stages. Their formation takes the fatigue process from the second stage to the final stage with a sharp increase in strain, and their further development seemed to lead the whole specimen to ultimate fatigue failure

Genetic variants associated with glaucomatous visual field loss in primary open-angle glaucoma

Abstract Primary open-angle glaucoma (POAG) is characterized by a progressive optic neuropathy with visual field loss. To investigate the genetic variants associated with visual field loss in POAG, Japanese POAG patients (n = 426) and control subjects (n = 246) were genotyped for 22 genetic variants predisposing to POAG that can be classified into those associated with intraocular pressure (IOP) elevation (IOP-related genetic variants) and optic nerve vulnerability independent of IOP (optic nerve-related genetic variants). The genetic risk score (GRS) of the 17 IOP-related and five optic nerve-related genetic variants was calculated, and the associations between the GRS and the mean deviation (MD) of automated static perimetry as an indicator of the severity of visual field loss and pattern standard deviation (PSD) as an indicator of the focal disturbance were evaluated. There was a significant association (Beta = − 0.51, P = 0.0012) between the IOP-related GRS and MD. The severity of visual field loss may depend on the magnitude of IOP elevation induced by additive effects of IOP-related genetic variants. A significant association (n = 135, Beta = 0.65, P = 0.0097) was found between the optic nerve-related, but not IOP-related, GRS and PSD. The optic nerve-related (optic nerve vulnerability) and IOP-related (IOP elevation) genetic variants may play an important role in the focal and diffuse visual field loss respectively. To our knowledge, this is the first report to show an association between additive effects of genetic variants predisposing to POAG and glaucomatous visual field loss, including severity and focal/diffuse disturbance of visual field loss, in POAG

Fermentation Ability of Gut Microbiota of Wild Japanese Macaques in the Highland and Lowland Yakushima: In Vitro Fermentation Assay and Genetic Analyses

Wild Japanese macaques (Macaca fuscata Blyth) living in the highland and lowland areas of Yakushima are known to have different diets, with highland individuals consuming more leaves. We aim to clarify whether and how these differences in diet are also reflected by gut microbial composition and fermentation ability. Therefore, we conduct an in vitro fermentation assay using fresh feces from macaques as inoculum and dry leaf powder of Eurya japonica Thunb. as a substrate. Fermentation activity was higher for feces collected in the highland, as evidenced by higher gas and butyric acid production and lower pH. Genetic analysis indicated separation of highland and lowland in terms of both community structure and function of the gut microbiota. Comparison of feces and suspension after fermentation indicated that the community structure changed during fermentation, and the change was larger for lowland samples. Analysis of the 16S rRNA V3-V4 barcoding region of the gut microbiota showed that community structure was clearly clustered between the two areas. Furthermore, metagenomic analysis indicated separation by gene and pathway abundance patterns. Two pathways (glycogen biosynthesis I and D-galacturonate degradation I) were enriched in lowland samples, possibly related to the fruit-eating lifestyle in the lowland. Overall, we demonstrated that the more leaf-eating highland Japanese macaques harbor gut microbiota with higher leaf fermentation ability compared with the more fruit-eating lowland ones. Broad, non-specific taxonomic and functional gut microbiome differences suggest that this pattern may be driven by a complex interplay between many taxa and pathways rather than single functional traits

Clinical demographics of patients in the genotype–phenotype correlation study.

<p>Clinical demographics of patients in the genotype–phenotype correlation study.</p